Provider Demographics
NPI:1912706201
Name:CHAN, MAKYLEE (MHRT-C, CADC)
Entity type:Individual
Prefix:
First Name:MAKYLEE
Middle Name:
Last Name:CHAN
Suffix:
Gender:
Credentials:MHRT-C, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 HURRICANE RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-2524
Mailing Address - Country:US
Mailing Address - Phone:207-595-5375
Mailing Address - Fax:
Practice Address - Street 1:103 PARK ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7203
Practice Address - Country:US
Practice Address - Phone:207-440-7922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC9042101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)